The healthcare sector is facing rapid changes in the wake of the coronavirus outbreak. The sector is deeply affected by the ongoing pandemic and is struggling to open up to patients. New safety measures have been imposed in all healthcare centers across the country, including hospitals, long term care centers, and private medical centers.

The American Academy of Dermatologists (commonly known as AAD) has issued multiple recommendations for dermatologists and aesthetic clinics in order to keep their practice staff and patients safe. Dermatology is one of the most exposed medical specialties during this period, as consultations are usually done face-to-face. To stop the spread of the virus, AAD recommends the use of teledermatology for consultations and long term care. Teledermatology guidelines have been issued for dermatology and aesthetic clinics. Also, clinics should impose specific safety measures for physical consultations.

Let's go over some of the most important safety and teledermatology guidelines healthcare providers should follow.

The reasons for the safety guidelines for dermatology and aesthetic clinics

We'll start by explaining the reasons behind these new safety rules. There are multiple factors that increase the risk of coronavirus transmission. The virus can easily be transmitted from healthcare workers to patients and vice versa, especially in an aesthetic or dermatology clinic. Here are the risk factors, explained:

- sneezing and coughing by patients, as well as by accompanying persons in the waiting areas; speaking, laughing, or taking deep breaths are also major risk factors;

- small investigation or consultation rooms, without adequate natural ventilation;

- central air conditioning, but without adequate filters or recirculation systems; all air conditioning systems must have high-efficiency particulate air (also known as HEPA) filtration systems; all rooms, including waiting areas and investigation rooms, must have excellent filtration equipment;

- overcrowding and inadequate distance between the healthcare provider and patients;

- the length of the procedure can also be a risk factor; for instance, long procedures, like full-face UI therapy treatment or whole-body laser hair reduction can be serious risk factors; most of these procedures cannot be done via teledermatology;

- certain type of dermatology procedures have a high-risk factor; these include PRP micro-needling treatment, various LASER treatments or crystal microdermabrasion; virtually all procedures that generate aerosols are also risky;

- handling equipment inadequately can be risky – for instance, patient chairs, desks, touch screens, medical equipment, patient forms, credit cards, cash, and other items;

Safety guidelines for dermatology and aesthetic clinics:

The American Academy of Dermatology has issued multiple recommendations for dermatology and aesthetic clinics operating in the United States. These safety guidelines are designed to keep both practice staff and patients safe during the pandemic. Here are the main guidelines:

- wipes and hand sanitizers will be placed in all populated rooms of the clinic; hand sanitizers should use a solution containing 70 percent ethyl alcohol or 0.5 percent sodium hypochlorite;

- all people are advised to maintain social distancing while in the clinic;

- communication should be done via nodding, waving, or smiling instead of shaking hands;

- patients should be educated about the signs and symptoms of a COVID-19 infection;

- all areas must be sanitized between patients and at the end of each day – chairs, faucet handles, door handles, light buttons, doorknobs, exam beds, exam tables, tabletops, and countertops; also, bathroom surfaces must be carefully sanitized every day;

Patient screening should be done in order to minimize the risk of exposure:

- dermatologists should ask patients if they have any respiratory infection symptoms or if they were in contact with other people that may have been exposed to the novel coronavirus; patients who have symptoms or were in contact with potential COVID-19 patients should be rescheduled; only emergency patients should be accepted;

- if the patient cannot be rescheduled, the patient must be provided with a mask and should be isolated in a separate examination room; make sure to notify other staff members, especially the staff that handles the patient; teledermatology is an excellent alternative during this period; make sure you follow the strict teledermatology guidelines according to AAD;

- all patients or visitors should maintain proper hygiene protocols, cough etiquette and should maintain social distancing;

- impose strict cleaning schedules – every dermatology or aesthetic clinic should have a cleaning schedule, detailing the frequency of cleaning for all high and low-touch surfaces; include every activity that will take place and what type of products will be used; include a description of the infection risks associated with this activity;

- waste bins – try to use no-touch waste bins for each procedure or examination room; use similar waste bins for the office area, the waiting area, and for restrooms; all waste bins should be lined with disposable liners;

- food and beverages – all pantry and eating utensils for the staff should be disposable; clients and patients should have their own water bottles; serving coffee or tea to patients or clients should be discouraged in all dermatology or aesthetic clinics; the pantry or dining area should be disinfected every 2 hours; all items that are frequently used should be disinfected regularly – these include cups, microwave ovens or tea kettles;

- cleaning staff should use high-quality PPE equipment, such as surgical masks, gloves, protective eye covering and shoe covers; cleaning staff should be well trained in hygiene protocols;

- cleaning the surfaces – every floor surface should be properly cleaned; these include the entrance lobbies, staircases, corridors, elevators, procedure rooms, counseling rooms, and consulting offices; make sure to clean other areas, like pantries, utility rooms, or storage rooms; cleaning should be done with 1 percent sodium hypochlorite solution or other alcohol-based disinfectants; cleaning should always start from cleaner areas to dirtier areas;

- cleaning frequently touched areas – every frequently touched area should be cleaned with alcohol-based sanitizers or sodium hypochlorite solutions

- cleaning bathroom areas – toilet floors, toilet seats, sinks, and soap dispensers should be cleaned with a phenolic detergent at least four times a day; patients and staff should use the toilet using a paper tissue to hold the handles; the toiled should be flushed while the seats are covered;

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